2018 a (brief) review of the year

Some naughty elves decorated the office
A collage of pictures of Christmas decorations in the office

Before the earth makes that turn moving the UK into 2019 I thought I’d do a 2018 roundup post because it’s been a pretty intense year. At Christmas 2017 I said my goal for 2018 was to become permanent staff even if it was still on reduced hours but to have the security of a proper contract not a zero hours one.

The year didn’t get off the best start with my first trip to a&e of the year on the 2nd of January this was also the only visit to a&e all year, just over two weeks after this I started a new medication Lamotragine a mood stabiliser. I’m sure that lamotragine has been the biggest reason that I haven’t self harmed its almost like it’s turned something off in my brain that’s made me not want to self harm anymore.

My main goal for the year came true in May when I became permanent staff and took over running the youth service, in November I passed my 6 month probation so now I’m officially permanent staff running a service, managing volunteers a year after I said I wanted to be permanent.

A picture of a letter confirming that I passed my 6 month probation

I’ve been under the mental health service again this year slowly adjusting my medication and I’ve now come off the antipsychotics, reduced one of the medications I was taking for anxiety and only taking the bets blockers as needed. I’ve gone from taking 5 different medications for my mental health to 3.

For someone who often struggles with change there have been so many this year, changes with my job, and the people I work with, two of the people I was closest with at work both left within a few weeks of each other which has been hard and still hasn’t fully sunk in. The office is definitely quieter and I’m missing my verbal sparring partner, I’ll also the person who will always find something positive in everything who took me outside to the carpark to cry because she knew I wouldn’t want anyone in the office to overhear me.

I’ve also become closer to other people at work including two who started at the same time as me, I’ve been out for various drinks and social events (enough to maybe get a reputation) and I’ve had some lovely feedback and support from my volunteers.

As an incredibly indecisive person who struggles to make a choice when there are too many desserts on the menu I bought myself an early Christmas present and got my first tattoo covering some of my self harm scars something very permanent but positive and I love it so much.

A collage of pictures of my new tattoo a caduceus with the words omnes te moriturum amant above it

So 2019 will be off to a busy start with work but also starting with a huge milestone of a year since the last time I self harmed. Of course my love for a certain tv show about a certain grumpy dr has been in full force in 2018 (is a tattoo taking the fandom too far?) and I’ve spent my time off over Christmas working my way through Sherlock, 2019 is looking like a busy year for my fandoms.

Happy new year or happy January or happy Tuesday whichever suits you

Georgiesaurus ☺️🦖

All Roads Lead to A&E

IMG_3951

“If you’re struggling you can go to a&e”

“If you really need support go to a&e”

“There’s always a&e if you’re in crisis”

Have you ever sat in a busy a&e waiting area? I have, 35 times between January 2015 and now. It’s not much fun, long waits, uncomfortable seats and lots of sick people. Now think about sitting in that environment when you’re in extreme emotional distress, maybe feeling suicidal or wanting to harm yourself, it’s not a very nice environment at the best of times let alone when you’re in crisis.

Someone at a mental health crisis planning meeting recently said that everyone under a mental health service should have a detailed crisis plan drawn up in collaboration with them, their mental health team and carers/ family/ partner where appropriate; this seems like a sensible suggest except there are no crisis services. Mental health isn’t 9 – 5 people are more likely to be in crisis outside those hours when there are less things to do or people to see and when they’re more likely to be alone.

As I’ve said before I’m a regular at a&e a “frequent flyer” or “frequent attender” but I’ve never been pre crisis or because I want to hurt myself it’s always been afterwards. I’m used to it now I know the drill busy Drs and nurses on 12 hour shifts earning far too little don’t have the time, energy and often experience to sit down and talk about what’s wrong they often see stitching my arms up as an inconvenience when there are people who aren’t there because of self inflicted injuries. Sometimes I see the psych liaison which is more waiting usually on the “observation ward” a holding pen in a&e where people are dumped to avoid breaching the 4 hour rule, because there’s no a&e in my borough the psych team aren’t from my area or the services that operate in it, I’ve been discharged by the psych team in the early hours of the morning with no way of getting home and told to wait in reception until the buses start running, when I told them I was suicidal I was given a leaflet (it went in the bin as soon as I left).

When I was under a mental health team they’d let them know but now a letter gets sent to my GP and that’s it, no follow up, no further support, no one pretends I won’t be back again, my self harm has been described as chronic and not a concern because it’s been going on so long despite having permanent damage to my arms and recently a cut that took over a year to heal. I don’t see a&e as a place of support it’s not the appropriate place for people with mental health problems yet all over the country it’s the only option for so many people, the police and ambulance service are as frustrated by it as I am, although the police have some powers to take people to the minimal crisis services that exist the ambulance service has no option but to take people in crisis to a&e whether they want to go or not.

It may sound defeatist to say I’d only go to a&e after I self harm because I don’t see the point in going beforehand but the experiences I’ve had in a&e don’t feel supportive and often leave me feeling worse. At the last mental health crisis service meeting I attended a paramedic spoke about her frustration at not being able to take someone in distress to a more appropriate place than a&e, despite there being two crisis cafes and a crisis and recovery house covered by the mental health trust my borough comes under (though not actually located in my borough) only the police can actually take someone there the paramedics only option is to take someone to a&e whether they want to go or not.

A&e should be the last option not the only option it should only be considered after all other options have been exhausted or if someone needs medical attention it shouldn’t be a place people in distress are routinely sent to.

 

A paper collage of an open mouth screaming

I know I’ve talked about cost before and I do understand the pressures placed on the NHS however this isn’t just about the actual finances but the attitudes towards money being spent on mental health care. Last year when the mental health trust that covers my area was considering putting in a crisis café I went to a consultation which was for service users, mental health professionals, third sector workers and generally anyone that might be interested or might consider bidding on to run the service.

Someone else attending the event worked out how much it would cost per person per night to attend a crisis café based on the figures from the model that the trust were basing it on and asked whether this was good value for money. This frustrated me for so many reasons one of them being why are we looking whether someone’s life is a cost effective use of funds and another was that the alternative to me is self harm and a&e.

It costs the NHS money to treat me – stitches and anaesthetic, dressings, bandages, Doctors and nurses time and psych liaison, if I get an ambulance to take me there because of blood loss or not feeling physically able to get there alone it costs the health service money and although I don’t know the exact figures (and I’m not sure I’d want to as it increases the guilt) but I’m sure it’s a lot more than the cost of attending a crisis café. I’ve seen people say that if you do it to yourself you shouldn’t expect the NHS to pay to fix it and while I can think of a few things I’d like to these people I also think once you start going down the route of denying people treatment if they’re responsible for the cause I think it’s a slippery slope towards finding blame for almost anything (didn’t notice your laces were undone sorry your fault, broke your leg skiing should have stayed at home).

Prevention is almost always better then cure and while I’m under no illusion that crisis cafés or any other crisis support would mean that no one went to a&e; I know it wouldn’t mean I never self harm but it would be an alternative. There’s a lot of talk at the moment especially with an election coming up about mental health and in particular the mental health of young people. I volunteer on a Youth wellbeing project and highly encourage mental health education and advice in schools but it doesn’t help the adults or children already experiencing mental health difficulties, it looks good on paper and even a liberal cynic like me can almost believe that’s not the only motive but it’s almost as if they want to write off those already in need of help and start again.
If we want people to thrive rather than just survive there needs to be more support, more money and more collaboration between the NHS and the third sector (actually collaboration not just expecting the third sector to pick up the pieces), the crisis concordat I’m part of has been cancelled twice in a row, it only meets every three months and the last one was in October there now won’t be another one until August. People with mental health problems deserve better and deserve more, too many people are left with nothing or sent home from a&e at 3 am with no way to get home, at this rate we cannot survive let alone thrive.

Dear Dr (a message to Healthcare professionals treating self harmers in hospital)

I’m a regular in my local, that probably doesn’t sound unusual or uncommon except I don’t mean my local pub I mean my local a&e department. Like around 1 in 4 people in the U.K. I have mental health problems and often require medical attention for self harm, I decided to write a post about my experiences in a&e as an open letter to medical professionals.

A collage picture of a wolf howling with song lyrics “Lately it’s hard to let you know that I’ll never learn” above and below

Dear Dr or health care professional

The NHS is underfunded and over stretched, you work long hours in a challenging conditions often with little thanks or support; it’s impossible to be oblivious to the current state of our health care system. When you’re juggling patients and trying to be in 3 places at once it’s not hard to understand why you might not want to spend an hour or more treating someone for self inflicted injuries especially when you’re coming to the end of a long shift; however you chose a career helping people and taking care of their medical needs and I am a person in need of medical attention.

If you’ve never experienced a mental health problem or felt a need to harm yourself then I don’t expect you to understand how I feel or why I do what I do but the way I got my injuries doesn’t change the way they should be treated. I’ve been treated in ways I can’t imagine people who are there after an accident would be. 
I’ve had wounds washed out in a sink in front of all the other cubicles and taken from one part of the department to another with nothing covering my arm while people stare at me often horrified, on one occasion my arm was covered so it wouldn’t scare the children in the paediatric a&e. 

I’ve been stapled with no local anaesthetic and told it’s fine because it doesn’t hurt (it does), I know this is in partly due to guidelines but I’ve also had malicious treatment where one Dr repeatedly pulled the Staples out and re did them all the while telling me if I didn’t stop I’d lose my arm while I sat in bed crying. I’ve had Drs tell me to think about how long it took them to treat me compared to the time it took me to hurt myself and when I’ve felt faint from blood loss and said I need to sit down told I can wait a couple of minutes. 

In my a&e notes it says most of the time that I’m not distressed or that I was making eye contact; apparently that means I’m fine. My mental state is frequently being judged as fine because I’m not shouting or being abusive or absconding however on times when I have been visibly upset I’m ignored.

I know accident and emergency staff are there to treat my physical injuries and leave the psychological side of things to the psych liaison but please remember that attached to the arm you’re treating is a person, I know my cuts can be deep and you may need another opinion but I’m not an exhibition for everyone to come and have a good look and discuss the damaged I’ve done, I see the signs that talk about dignity privacy and respect yet that doesn’t seem to apply if you’re a mental health patient; a little discretion wouldn’t hurt.

This isn’t intended as a criticism of the NHS I know I’d be dead without it but I didn’t choose to be this way, it’s something I’ve not been able to break away from despite treatment and no amount of snapping elastic bands of holding ice cubes has ever replaced it as a coping mechanism.

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